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. 2009 Feb 3;22(8):504–512. doi: 10.1002/clc.4960220804

Different prognostic significance of right and left ventricular diastolic dysfunction in heart failure

Henry C M Yu 1, John E Sanderson 1,✉
PMCID: PMC6656122  PMID: 10492839

Abstract

Background: Left (LV) and right (RV) ventricular diastolic dysfunction is common in heart failure but the prognostic value of RV diastolic dysfunction is not known.

Hypothesis: As a follow‐up to a previously undertaken study, this study was carried out to investigate whether LV and RV diastolic dysfunction affect prognosis differently and, in addition, whether changes in diastolic filling patterns over time correlate with clinical outcome.

Methods: We studied a cohort of 105 patients (mean age 62.7± 1.3 years, 66% male) with heart failure (ejection fraction < 50%) by Doppler echocardiography in both RV and LV.

Results: An LV restrictive filling pattern (RFP) was present in 48% of the patients and, when compared with non‐RFP subgroups, it was associated with poorer systolic function, higher New York Heart Association functional class, and higher cardiac mortality at 1 year (all p < 0.001). The coexistence of an LV‐RFP and poor LV systolic function (ejection fraction < 25%) markedly decreased the 1‐year survival that was significant when compared with other subgroups (p = 0.001). In contrast, RV diastolic dysfunction that occurred in 21% of patients was not a prognostic factor for mortality either alone or in combination with LV diastolic dysfunction, but predicted nonfatal hospital admissions for heart failure or unstable angina (p = 0.016).

Conclusion: An LV restrictive filling pattern is a powerful predictor of a poor prognosis, especially when combined with low ejection fraction, but in this study RV diastolic dysfunction did not appear to be an independent predictor of subsequent mortality.

Keywords: heart failure, diastole, prognosis, echocardiography

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References

  • 1. Rihal CS, Nishimura RA, Hatle LK, Bailey KR, Tajik AJ: Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis. Circulation 1994; 90: 2772–2779 [DOI] [PubMed] [Google Scholar]
  • 2. Walsh RA: Evaluation of ventricular diastolic function using invasive techniques. J Cardiol Imaging 1990; 4: 1–9 [Google Scholar]
  • 3. Bonow RO, Bacharach SL, Green MV, Kent KM, Rosing DR, Lipson LC, Leon MB, Epstein SE: Impaired left ventricular diastolic filling in patients with coronary artery disease: Assessment with radionuclide angiography. Circulation 1981; 64: 315–323 [DOI] [PubMed] [Google Scholar]
  • 4. Magorien DJ, Shaffer P, Bush CA, Magorien RD, Kolibash AJ, Leier CV, Bashore TM: Assessment of left ventricular pressure‐volume relations using gated‐radionuclide angiography, echocardiography, and micro‐manometer pressure recordings: A new method for serial measurements of systolic and diastolic function in man. Circulation 1983; 67: 844–853 [DOI] [PubMed] [Google Scholar]
  • 5. Appleton CP, Hatle LK, Popp RL: Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–440 [DOI] [PubMed] [Google Scholar]
  • 6. Nishimura RA, Abel MD, Hatle LK Tajik AJ: Assessment of diastolic function of the heart: Background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc 1989; 64: 181–204. [DOI] [PubMed] [Google Scholar]
  • 7. Takenaka K, Dabestani A, Gardin JM, Russell D, Clark S, Allfie A, Henry WL: Pulse Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. Am J Cardiol 1986; 58: 143–147 [DOI] [PubMed] [Google Scholar]
  • 8. Nishimura RA, Tajik AJ: Quantitative hemodynamics by Doppler echocardiography: A non‐invasive alternative to cardiac catheterization. Prog Cardiovasc Dis 1994; 36: 309–342 [DOI] [PubMed] [Google Scholar]
  • 9. Pozzoli M, Capomolla S, Cobelli F, Tavazzi L: Reproducibility of Doppler indices of left ventricular systolic and diastolic function in patients with severe chronic heart failure. Eur Heart J 1995; 16: 194–200 [DOI] [PubMed] [Google Scholar]
  • 10. Pokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA: Determination of parameters of left ventricular diastolic filling with pulse Doppler echocardiography: Comparison with cineangiography. Circulation 1985; 71: 545–550 [DOI] [PubMed] [Google Scholar]
  • 11. Appleton CP, Hatle LK, Popp RL: Demonstration of restrictive ventricular physiology by Doppler echocardiography. J Am Coll Cardiol 1988; 11: 757–768 [DOI] [PubMed] [Google Scholar]
  • 12. Pinamonti B, Di Lenarda A, Sinagra G, Camerini F, and The Heart Muscle Disease Study Group: Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: Clinical, echocardiographic and hemodynamic correlations and prognostic implications. J Am Coll Cardiol 1993; 22: 808–815 [DOI] [PubMed] [Google Scholar]
  • 13. Xie GY, Berk MR, Smith MD, Gurley JC, DeMaria AN: Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol 1994; 24: 132–139 [DOI] [PubMed] [Google Scholar]
  • 14. Shen WF, Tribouilloy C, Rey JL, Baudhuin JJ, Boey S, Dufosse H, Lesbre JP: Prognostic significance of Doppler‐derived left ventricular diastolic filling variables in dilated cardiomyopathy. Am Heart J 1992; 124: 1524–1533 [DOI] [PubMed] [Google Scholar]
  • 15. Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS: Right ventricular diastolic dysfunction in heart failure. Circulation 1996; 93: 1509–1514 [DOI] [PubMed] [Google Scholar]
  • 16. Grossman W: Diastolic dysfunction in congestive heart failure. N Engl J Med 1991; 22: 1557–1564 [DOI] [PubMed] [Google Scholar]
  • 17. Wheeldon NM, Clarkson P, MacDonald TM: Diastolic heart failure. Eur Heart J 1994; 15: 1689–1697 [DOI] [PubMed] [Google Scholar]
  • 18. Kannel WB: Epidemiological aspects of heart failure. Cardiol Clin 1989; 7: 1–9 [PubMed] [Google Scholar]
  • 19. Bourassa MG, Gurne O, Bangdiwala SI, Ghali JK, Young JB, Rousseau M, Johnstone DJ, Yusuf S: Natural history and patterns of current practice in heart failure. J Am Coll Cardiol 1993; 22 (suppl): 14A–19A [DOI] [PubMed] [Google Scholar]
  • 20. Fuster V, Gersh EJ, Giuliani ER, Tajik AJ, Brandenburg RO, Frye RL: The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 1981; 47: 525–531 [DOI] [PubMed] [Google Scholar]
  • 21. Franciosa JA, Wilen M, Ziesche S, Cohn JN: Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol 1983; 51: 831–836 [DOI] [PubMed] [Google Scholar]
  • 22. Vanoverschelde JLJ, Raphael DA, Robert AR, Cosyns JR: Left ventricular filling in dilated cardiomyopathy: Relation to functional class and hemodynamics. J Am Coll Cardiol 1990; 15: 1288–1295 [DOI] [PubMed] [Google Scholar]
  • 23. Yu CM, Sanderson JE, Shum IOL, Chan S, Yeung L, Hung YT, Cockram CS, Woo KS: Diastolic dysfunction and natriuretic peptides in systolic heart failure—higher ANP and BNP levels are associated with the restrictive filling pattern. Eur Heart J 1996; 17: 1694–1702 [DOI] [PubMed] [Google Scholar]
  • 24. Packer M: Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure. Circulation 1990; 81 (suppl III): III‐78–III‐86 [PubMed] [Google Scholar]
  • 25. Davies SW, Fussell AL, Jordan SL, Poole‐Wilson PA, Lipkin DP: Abnormal diastolic filling patterns in chronic heart failure: Relationship to exercise capacity. Eur Heart J 1992; 13: 749–757 [DOI] [PubMed] [Google Scholar]
  • 26. DiSalvo TG, Mathier M, Semigran MJ, Dec GW: Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol 1995; 25: 1143–1153 [DOI] [PubMed] [Google Scholar]
  • 27. Weber KT, Brilla CG, Janicki JS: Myocardial fibrosis: Functional significance and regulatory factors. Cardiovasc Res 1993; 27: 341–348 [DOI] [PubMed] [Google Scholar]
  • 28. Beltrami CA, Finato N, Rocco M, Feruglio GA, Puricelli C, Cigola E, Quaini F, Sonnenblick EH, Olivelti G, Anversa P: Structural basis of end‐stage failure in ischemic cardiomyopathy in humans. Circulation 1994; 89: 151–163 [DOI] [PubMed] [Google Scholar]
  • 29. Santamore WP, Constantinescu M, Minczak BM, Hock CE, Papa L: Contribution of each ventricular wall to ventricular interdependence. Basic Res Cardiol 1988; 83: 424–430 [DOI] [PubMed] [Google Scholar]
  • 30. Lee CH, Xiao HB, Gibson DG, Jugular venous ‘a’ wave in dilated cardiomyopathy: Sign of abbreviated right ventricular filling time. Br Heart J 1991; 65: 342–345 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Gradman A, Deedwania P, Cody R, Massie B, Packer M, Pitt B, Goldstein S: Predictors of total mortality and sudden death in mild to moderate heart failure. J Am Coll Cardiol 1989; 14: 564–570 [DOI] [PubMed] [Google Scholar]
  • 32. Shah PM, Archibald D, Lopez B, Cohn JN: Prognostic value of echocardiographic parameters in chronic congestive heart failure: The VHEFT study (abstr). J Am Coll Cardiol 1987; 9:202A [Google Scholar]
  • 33. Douglas PS, Morrow R, Ioli A, Reichek N: Left ventricular shape, afterload, and survival in idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1989; 13: 311–315 [DOI] [PubMed] [Google Scholar]
  • 34. Little WC, Ohno M, Kitzman DW, Thomas JD, Cheng C‐P: Determination of left ventricular chamber stiffness from the time of deceleration of early left ventricular filling. Circulation 1995; 92: 1933–1939 [DOI] [PubMed] [Google Scholar]
  • 35. Berman GO, Reichek N, Brownson D, Douglas PS: Effects of sample volume location, image view, heart rate and age on tricuspid velocimetry in normal subjects. Am J Cardiol 1990; 65: 1026–1030 [DOI] [PubMed] [Google Scholar]
  • 36. Sartori MP, Quinones MA, Kuo LC: Relation of Doppler‐derived left ventricular filling parameters to age and radius/thickness ratio in normal and pathologic states. Am J Cardiol 1987; 59: 1179–1182 [DOI] [PubMed] [Google Scholar]
  • 37. Riggs TW, Snider AR: Respiratory influence on right and left ventricular diastolic function in normal children. Am J Cardiol 1989; 63: 858–861 [DOI] [PubMed] [Google Scholar]
  • 38. Berk MR, Xie G, Kwan OL, Evans J, Kotchen T, Kotchen JM, DeMaria AN: Reduction of left ventricular preload by lower body negative pressure alters Doppler transmitral filling patterns. J Am Coll Cardiol 1990; 16: 1387–1392 [DOI] [PubMed] [Google Scholar]
  • 39. Masuyama T, St Goar FG, Alderman EL, Popp Richard L: Effects of nitroprusside on transmitral flow velocity patterns in extreme heart failure: A combined hemodynamic and Doppler echocardiographic study of varying loading conditions. J Am Coll Cardiol 1990; 16: 1175–1185 [DOI] [PubMed] [Google Scholar]
  • 40. Yu CM, Sanderson JE: Right and left ventricular diastolic function in patients with and without heart failure: Effect of age, sex, heart rate, and respiration on Doppler‐derived measurements. Am Heart J 1997; 134: 426–434 [DOI] [PubMed] [Google Scholar]

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